Racial/ethnic differences in use of alcohol, tobacco, and marijuana: Is there a cross-over from adolescence to adulthood?
Introduction
In adolescence and young adulthood, Blacks are less likely to use alcohol and tobacco (Baker et al., 2003, Breslau et al., 2006, Hasin et al., 2007, Pacek et al., 2012, Swendsen et al., 2012, Wu et al., 2011, Zapolski et al., 2014), and equally or less likely to use marijuana depending on the time frame assessed (Pacek et al., 2012, Wu et al., 2011), compared with non-Hispanic Whites (henceforth referred to as “Whites”). However, among users of the substances, Blacks progress from use to dependence faster than Whites (Alvanzo et al., 2011), have longer duration of use (Caetano and Kaskutas, 1995), and experience more substance-related consequences than other racial/ethnic groups. Specifically, in early adulthood, Blacks are more likely to experience legal and social/interpersonal problems related to use (Witbrodt et al., 2014), arrest/incarceration for marijuana-related offenses (Ramchand et al., 2006), and injury (Keyes et al., 2012a, Witbrodt et al., 2014). At later stages of adulthood, Blacks have higher rates of lung cancer mortality (Gadgeel and Kalemkerian, 2003), and cardiovascular outcomes (Volkow et al., 2014). The reasons for the contrast in race/ethnic differences in substance use patterns, and in consequences of use, both in young adulthood and as individuals progress through the lifecourse, among users are unknown. Many of these consequences occur later in the lifecourse than adolescence or early adulthood, suggesting potential explanations of the contrast.
Explanations underlying these observations are emerging. While overall rates of alcohol, marijuana, and tobacco use among Blacks are generally lower than among Whites, several large-scale epidemiologic studies show a convergence in use by age, with rates becoming more similar, or ‘crossing-over’ by age (Caetano, 1984, Feigelman and Lee, 1995, Finlay et al., 2012, Kandel et al., 2011, Pampel, 2008, Robins, 1985, Watt, 2008). While studies vary in the age at which this cross-over occurs, generally the late 20s and early to mid 30s are found to be the critical developmental period for cross-over in substance use (Pampel, 2008, Watt, 2008). Therefore, while lower overall prevalence of use among Black compared with White adolescents is driven by patterns in these early life stages, higher use among Blacks compared with Whites in later stages of adulthood may drive the greater burden of substance use consequences among Blacks. Our understanding of the epidemiological patterns of substance use across race/ethnicity over the lifecourse, however, remains inadequate for several reasons.
First, studies of racial/ethnic differences across the lifecourse are predominately comprised of large cross-sectional samples of adolescents (Bachman et al., 1991, Feigelman and Lee, 1995, Kandel, 1995, Kandel et al., 1976, Swendsen et al., 2012, Wallace and Bachman, 1991) or adults (Alvanzo et al., 2014, Dunlop et al., 2003; D. Herd, 1990, Wallace, 1999, Watt, 2008, Witbrodt et al., 2014). Longitudinal studies are largely community and convenience samples with limited variation in age ranges (Brown et al., 2005, Caetano and Kaskutas, 1995, Caetano and Kaskutas, 1996, Cooper et al., 2008, Finlay et al., 2012, Myers et al., 1995, Weaver et al., 2011), with notable exceptions (Chen and Jacobson, 2012; K. M. Harris et al., 2006, Pampel, 2008). These longitudinal samples suggest convergence in tobacco (White et al., 2004) and marijuana use (Finlay et al., 2012), but not for alcohol (Caetano and Kaskutas, 1995, Caetano and Kaskutas, 1996). Data from the National Longitudinal Study of Youth indicated convergence in rates of cigarette smoking over time between White and Black Americans followed into their mid-thirties (Pampel, 2008). Confirmation of these findings and expansion to examine possible gender differences is necessary to fully elucidate lifecourse patterns of substance use.
Second, the effects of socio-economic status on racial/ethnic differences in substance use remain inadequately understood, and some data suggest that racial/ethnic differences in age-related variation could be fully accounted for by socio-economic indicators (Watt, 2008). The extent to which racial/ethnic differences persist despite mean differences in socio-economic status, versus other cultural or social group differences (Zapolski et al., 2014), is important for inferring conclusions from the data on racial and ethnic differences across the lifecourse. For alcohol, available evidence indicates that while income is positively associated with use in general (Keyes and Hasin, 2008), among those in poverty, Black men have higher rates of heavy drinking compared with Whites (Ford et al., 2007, Gilman et al., 2008, Jones-Webb, 1998, Jones-Webb et al., 1997). Examining these relations across other substances with rigorous control for socio-economic factors is critical.
Third, the role of gender in substance use is critically important to understanding its etiology and consequences. While social norms regarding substance use are changing for women (Goodwin et al., 2009, Keyes et al., 2008a, Keyes et al., 2010b), drinking and other substance use remains less acceptable for women than for men (Ahern et al., 2008, Greenfield and Room, 1997, Jones-Webb, 1998, Keyes et al., 2011). Recent evidence indicates that Whites are more susceptible to influence from social norms regarding substance use compared with Blacks (Keyes et al., 2012b) and report more positive attitudes toward drinking (Caetano and Clark, 1999; D. Herd, 1997), suggesting that the intersection of race and gender in trajectories of substance use may shed light on potential emerging disparities. Recent evidence from cross-sectional data indicate, for example, that Black women have higher rates of alcohol-related problems relative to White women at equal levels of alcohol consumption (Witbrodt et al., 2014). In addition, Black men have higher rates of alcohol-related problems among those with low levels of heavy drinking (Witbrodt et al., 2014); higher rates of incident alcohol disorders among Black compared with White women, although not among Black compared with White men over the age of 29 (Grant et al., 2012). Thus, examining the intersection of race and gender when examining patterns of substance use over time may yield important insights about the processes that underlie racial/ethnic differences in substance use across the lifecourse.
Using data from the first three waves of a nationally representative US sample followed from adolescence through the early twenties (National Longitudinal Study of Adolescent Health [Add Health]), Harris et al. (2006) documented increases in alcohol, marijuana, and tobacco use during the transition to adulthood for both White and Black participants, but no evidence of convergence or cross over, though this was not specifically tested (K. M. Harris et al., 2006). More recently, in the same sample followed to early to mid-30s, Chen and Jacobson (2012) documented age-related differences by race and ethnicity in patterns of any substance use. Consistent with prior evidence, Whites had higher prevalence of alcohol, tobacco, and marijuana use in early adulthood. Differences between Black and White young adults either diminished (alcohol) or crossed over (tobacco and marijuana) by the early to mid-30s. However, trajectories of quantity and frequency of use among users may differ in important ways from trajectories of any use. For example, previous research has demonstrated that Black young adults have different drinking patterns compared with Whites, including different beverage preferences and premise utilization patterns (Zapolski et al., 2014). Examination of such variation in quantity and frequency is critical, as adverse physical health outcomes secondary to substance use, both in young adulthood and through the lifecourse, are only exhibited at high and chronic levels of consumption (Connor, 2006). Further, existing studies in these data have not controlled for important socio-economic differences across groups; a full accounting is critical in inferring the extent to which racial/ethnic differences persist over and above socio-economic circumstances.
Informed by previous studies in these data, we tested differences in trajectories of alcohol, marijuana, and tobacco use among Black and White participants in the Add Health sample. We examine differences in quantity and frequency of alcohol, tobacco, and marijuana use between Black and White respondents from adolescence (mean age 16) through adulthood (mean age 29), stratified by gender, robustly testing modification of association with race/ethnicity by survey wave, and fully adjusting for multiple measures of socio-economic position to comprehensively investigate the evidence for convergence and/or cross-over of risk among Black and White participants during the transition to adulthood.
Section snippets
Sample
Data were drawn from Add Health (K.M. Harris et al., 2009), an ongoing national-representative longitudinal study to address health, behaviors, and relationships from adolescence through adulthood. The study began with approximately 90,000 adolescents sampled in school in 1994–1995; 20,745 of these underwent in-depth home interviews (1995, age 12–21). Waves 2 through 4 attempted re-interview of respondents who underwent the in-depth interviews at Wave 1. However, children who graduated high
Descriptive statistics on substance use
Fig. 1, Fig. 2, Fig. 3 show the trajectory of tobacco, alcohol, and marijuana among Black and White respondents at each wave of the study, by gender.
Sensitivity analyses
Due to attrition in the sample over time, we conducted a complete case analysis of only those respondents who completed all four waves of the study with complete data. Results are provided in Online Tables 2 and 3. Results remain largely unchanged among those who completed all four waves. One notable difference is that the difference-in-difference estimates for the association between race and marijuana use among women are no longer significant; however, the results are in the same direction,
Discussion
We examined the evidence for convergence and cross-over in the prevalence of alcohol, cigarette, and marijuana use between White and Black men and women sampled in adolescence from schools in the US as they age from adolescence to adulthood. Importantly, the present study attends rigorously to socio-economic differences, controlling for a range of economic indicators including material deprivation, geographic location, and supplementation with use of public assistance. We summarize the results
Financial disclosure/conflict of interest
The authors report no conflicts of interest.
Acknowledgments
This research was supported by the National Institute of Alcohol Abuse and Alcoholism (K01AA021511, Keyes), National Institute of Child and Human Development (R01HD060072, Martins), National Heart Lung and Blood Institute (K01HL103199, Suglia). The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. This research uses data from Add Health, a program
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